The revascularization technique does not impact renal function after proximal abdominal aortic aneurysm open repair

Background To report the postoperative renal function stratified according to the visceral vessels (VV) revascularization technique used during proximal abdominal aortic aneurisms (p-AAA) open surgical repair (OR). Methods Data from all patients with p-AAA who were submitted to OR between 2010 and 2015 at our Institute were prospectively collected and analyzed. A postoperative deterioration of the estimated glomerular filtration rate (eGFR) by 25% within four days was defined as acute kidney injury (AKI) 1. Only AKI 2 (50% decrease in eGFR) and AKI 3 (75% decrease in eGFR) were considered significant for renal impairment after the procedure. Primary study end point was defined as the presence of AKI 2 or 3. Secondary end points were 30-day mortality and/or any major adverse event. Results During the study period, 157 consecutive patients (145 men and 12 women; mean age: 72±7 years) were treated. Sixty (38,2%) were cross-clamped supraceliac, 53 (33,8%) were cross-clamped suprarenal and 44 (28%) were cross- clamped inter/infrarenal. Vessel reattachment was not needed in 104 cases (66.2%). A beveled aortic anastomosis was performed in 10 (6.4%) patients, a beveled anastomosis and left renal artery (LRA) direct revascularization in 10 (6.4%), Crawford inclusion technique in 11 (7%), Crawford inclusion technique and LRA direct revascularization in six (3.8%) and direct revascularization of one or more renal arteries in 16 (10.2%). Peri-operative mortality was 1.9%. An increased incidence of AKI 2 and AKI 3 was observed in patients undergoing revascularization of all VV with LRA separate revascularization: in particular 40% of of beveled proximal anastomosis (p=0.001) and in 16.7 of Crawford inclusion technique (p=0.025) respectively. On the other hand, those patients who did not require any VV revascularization had a decreased incidence of AKI>1 (p=0.010). The follow-up data of 63.6±21 months shows no significant difference in renal function according to the revascularization technique used compared to the perioperative period. Conclusions Postoperative renal failure after p-AAAs repair is still a major concern although perfusion techniques and organ protection are important to reduce its frequency. Despite recent development of complex endovascular techniques, OR, when offered in high-volume centers, remains safe, effective and durable.